View clinical trials related to Anesthesia.
Filter by:Regional anaesthesia is the performance of spinal, epidural or peripheral nerve blocks to allow patients to undergo surgery awake and to provide post-operative pain relief. Anaesthetists inject local anaesthetic using specialist needles close to nerves to prevent transmission of pain. Hand-held ultrasound is often used by anaesthetists to direct these needles to the correct position i.e. close to, but not in the nerve itself. If the needle is not adequately seen using the hand-held ultrasound it may pierce the nerve causing permanent nerve damage and significant patient harm. Within the time and resource constraints of postgraduate medical training, it would be advantageous to optimise expertise acquisition of practical skills with a cheap, self-directed educational intervention. Therefore, the aim of this study is to determine whether gaze training is associated with improved performance of an ultrasound-guided needle task. The investigators hypothesise that improved gaze control will translate to better technical performance of an ultrasound-guided regional anaesthesia task.
The growing increase in the number of gynecomastia surgeries has resulted in an increased need for anesthetic techniques with improved pain reduction, safety, and fewer complications. The aim of this work is to compare the efficacy of ultrasound guided thoracic interfascial plane block and ultrasound guided thoracic paravertebral block for anesthesia in gynecomastia surgery.
Regional anesthesia is frequently used in major surgery in association with general anesthesia to ensure adequate postoperative patient analgesia and to decrease the intra- and postoperative use of systemic analgesic drugs. Epidural analgesia (EP) is considered the standard regional analgesic technique that is widely used in abdominal surgery. Nonetheless, it has some limitations such as in colorectal surgery where complications in the form of muscular weakness, hemodynamic instability, and postural hypotension result in delayed patient ambulation. For these limitations, peripheral nerve blocks can be considered safer with less incidence of complications compared to the central neuraxial blocks especially with the use of ultrasound (US) as a guide in their techniques. Also, avoidance of the hemodynamic instability that may affect the postoperative kidney function can be considered an important issue in patients with risk for postoperative acute kidney injury (AKI). One of the latest techniques in the field of regional anesthesia is the quadratus lumborum (QL) block, which is based on US-guided injection of a local anesthetic agent into the thoracolumbar fascia surrounding the QL muscle. Several different approaches were described depending on the injection sites, for example, lateral, posterior, and anterior approaches . According to the ASRA-ESRA Delphi consensus, there was no consensus on naming quadratus lumborum block types where posterior QL had the strongest consensus in abdominal wall analgesia with 71%. After the QL block, there is evidence that the injectate spreads to the paravertebral space where it blocks the thoracolumbar nerves and the thoracic sympathetic trunk. Because it produces an extensive sensory block leading to adequate postoperative analgesia besides decreasing the systemic analgesic consumption, QL block is now considered an effective regional block that can be used in major abdominal surgery. 40% of the cases diagnosed as having AKI occurred as a postoperative complication. Cardiac surgery carries the highest risk for AKI (18.7%), whereas general surgery comes second (13.2%). The risk factors of developing AKI may be general or causes related to the type and the setting of the surgery. Fluid depletion is one of the major factors that can occur perioperatively and leads to renal hypoperfusion, with subsequent renal arteriolar changes, attempting to maintain a normal glomerular filtration rate. The sympathetic effects of the neuroendocrine hormones may lead to renal vasoconstriction, aiming to redistribute the blood to the medulla; however, it may lead to renal ischemia. The renal blood flow can be assessed by a rapid bed-side noninvasive technique, using the renal Doppler resistive index (RI), which is one of the most fundamental parameters assessing renal perfusion, because it reflects the degree of the vascular resistance inside the kidney vascular bed and can be used to assess the modifications and the changes that occur in the renal blood flow. No previous studies so far discussed the effect of QL block on postoperative creatinine and blood ureal nitrogen (BUN) levels. While, regarding epidural analgesia, multiple articles are investigating the effect of epidural on postoperative kidney function using various indices, such as serum creatinine, BUN, sodium clearance, and urine output. As far as the authors know, this is the first study using the RI renal flow as a comparative parameter between the QL block and EP analgesia. This study aimed to assess the analgesic efficacy of QL block compared with epidural anesthesia as a primary outcome using the 10-point visual analog scale (VAS), time to first morphine requirement, and 24-hour morphine consumption. Also, to study the effect of both on postoperative kidney function as a secondary outcome using serum creatinine and BUN and renal flow assessment using renal Doppler.
The purpose of this study is to investigate the impact of supraphysiologic oxygen (hyperoxia) on myocardial function in anaesthetized patients with coronary artery disease.
To investigate the influence of PEEP (Positive end-expiratory pressure), changes in preload (patient position) and changes in afterload (phenylephrine) on ultrasound measures of renal perfusion in patients after uncomplicated cardiac surgery. To investigate the effects of phenylephrine on both invasive measures of the systemic- and pulmonary circulation and, secondarily, to assess the induced changes in echocardiographic indices of left- and right ventricular systolic- and diastolic function.
Patients undergoing thoracotomy in thoracic surgery are prone to have complications of delayed recovery from general anesthesia and perioperative instable hemodynamics due to the relatively invasive procedures and patient's underlying morbidity. Therefore, intraoperative monitoring and corresponding management are of great importance to prevent relevant complications in thoracic surgery. This study aims to investigate the clinical benefits of two intraoperative monitoring techniques in patients undergoing thoracotomy surgery, including depth of anesthesia and minimally invasive cardiac output monitoring. First, M-Entropy system will be used to measure the depth of anesthesia and be evaluated regarding the effect of spectral entropy guidance on postoperative recovery. Second, we will apply ProAQT device in guiding goal-directed hemodynamic therapy and assess its impact on occurrence of postoperative pulmonary complications and recovery. In this study, we will conduct a factorial parallel randomized controlled trial and use the method of stratified randomization to evaluate both two monitoring technologies in the same patient group. The results of this study will provide important evidence and clinical implication for precision anesthesia and enhanced recovery after surgery (ERAS) protocol in thoracic surgery.
This study aims to investigate the association between hyperlactatemia and neurological disability, length-of-stay and mortality in patients who undergo tumorcraniotomy. The risk factors that induce lactat accumulation will also be explored.
This study is designed to formally evaluate the performance of the QTOF, as compared with the newest commercially available NMB monitoring equipment, EMG (the TwitchView).
The primary aim is to verify if camel milk consumption has an impact on the amount of Midazolam needed to achieve a satisfactory level of sedation for oocyte retrieval, compared to patients never having consumed camel milk.
The process of surgery is a controlled trauma to the body. Trauma induces changes in metabolic function that have evolved to help the body survive injury. The normal balance among use of sugar, fat, and protein for energy production is thought to change during trauma and surgery. This altered metabolic function may contribute to adverse outcomes from surgical procedures especially in the setting of patients with obesity or Type 2 Diabetes Mellitus. However, very little is known about the specific changes in metabolism that occur during surgical procedures. The main objective of this project is to describe the metabolic changes that occur during a typical surgical procedure in detail. In order to measure the alterations in the balanced use of sugar, fat, and protein during surgery we will collect blood samples from patients before, during, and after spinal surgical procedures. Subjects will be enrolled in the pre-operative hold area, give informed consent, and have a dedicated peripheral IV catheter placed. We will recruit patients who are normal weight without diabetes, obese without diabetes, and obese with diabetes. The first specific aim is to characterize the metabolic changes in sugar, fat, and protein balance during surgery in metabolically normal subjects. The second specific aim to examine if there are differences in these changes in subjects who are obese or have diabetes. The final specific aim is to measure the changes in metabolism at high resolution using a method called metabolomics, which is analogous to genome profiling. This method measures hundreds of compounds produced in different amounts as metabolic balance changes. The major impacts that may be derived from these data range from a more thorough understanding of metabolism under trauma to identification of new markers for risk stratification and intervention to improve clinical outcomes. These data will help build the foundation for new approaches to understanding the physiological and metabolic responses to stress and trauma.